Wednesday, July 21, 2010

The Science Blog on guardian.co.uk has an incredible, insightful article about Osamu Tezuka and his famous doctor creation Black Jack, bringing to light not only the popularity of the character but also the effect he has had on issues regarding the medical profession in Japan. This is definitley worth reading for any and all Black Jack fans.

So far in this blog series on graphic medicine I've been looking at medical comics in the west. Now I look east to the work of the "Father of manga" (Japanese comics) Osamu Tezuka. A talented writer, artist and animator, Tezuka used his medical education to inform his anatomically accurate depictions of surgery.

Tezuka was born in Toyanaka City, Osaka, in 1928. Though he attended medical school and became a licensed physician, he chose not to work as a doctor and instead devoted himself to writing and drawing manga and making animated films.

Over the course of his long career Tezuka became a defining force in shaping the genre, publishing more than 700 manga running to more than 150,000 pages. Early Tezuka characters had large eyes, inspired by their American counterparts Betty Boop and Disney's Bambi. Large eyes have since become a stylistic hallmark of the whole genre.

As well as countless other titles including the world famous Astro Boy, Tezuka produced three notable medical manga: Black Jack, Ode to Kirihito, and Tezuka's Ancestor, Dr. Ryoan.

The latter is the story of Tezuka's grandfather, doctor to a samurai warrior during Japan's Meiji period. The other two works, fiercely critical of the Japanese medical establishment, have inspired a generation of manga artists (mangaka) as well as shaping the national debate about medical reform in Japan.

Ode to Kirihito was originally published in Japan as a series in the twice-monthly manga magazine Big Comic from 1970 to 1971. The story follows Dr Kirihito Osanai as he seeks a cure for the life-threatening (and thankfully fictional) Monmow disease which transforms people into dog-like creatures. When Kirihito himself becomes infected, he travels the world reflecting on his alienation and searching for a cure. In this 832-page epic, Tezuka deals with the anguish and moral dilemmas of both doctors and patients with piercing insight.

"For Tezuka, a doctor is not just someone who heals the body, but someone who appreciates the value of life, and inspires others to value it as well," said Ada Palmer, a historian at A&M University Texas and manga scholar. "In Tezuka's Buddhist cosmology all life is sacred and nothing is more valuable than creating or continuing life."

Ode to Kirihito expresses Tezuka's frustration at what he saw as an ineffectual medical establishment. It is one of a number of later social critique stories written by Tezuka that had only a limited impact in the context of his general body of work.

By contrast, Tezuka's medical manga Black Jack has been hugely successful since its original run in Weekly Shonen Champion from 1973 to 1984. In Black Jack, Tezuka depicted the physician he would like to have been had he continued with his medical career. An extremely gifted but unlicensed surgeon, Black Jack performs complicated operations on humans and animals and charges extortionate prices for his services.
Black Jack manga comic, cover image Black Jack, cover image

"The outrageous fees he charges are a test to make sure his patients truly appreciate that life itself is more valuable than any amount of money," said Palmer. Rejected by the medical community, he mostly provides his services to criminals and outlaws on the fringes of society. The series ran for more than 230 episodes.

Tezuka used his experience as a physician to draw anatomically accurate surgical scenes in Black Jack. His highly stylised cartoon figures were set against realistic landscapes and medically accurate depictions of the tissues of the human body. This attention to detail set the book apart from what had come before, and inspired many more mangaka to follow his lead.

"Many of the operations which Black Jack performs are astounding, sometimes impossible, but Tezuka's grounding in medicine means they are almost always convincingly portrayed," said Paul Gravett, comics historian and author of Manga: Sixty Years of Japanese Comics.

Indeed there are several points in Black Jack where Tezuka chose to reject medical plausibility. The superhuman surgeon can perform complex surgical operations from memory in complete darkness, for example. In one episode Black Jack operates on himself without anaesthetic. Despite this degree of poetic licence the manga has been enormously influential.

Black Jack remains one of the most popular manga of all time in Japan. "I have never met a Japanese person who wasn't familiar with Black Jack, even those who don't usually read manga," said Palmer. "If Astro Boy is the Japanese Superman, Black Jack is the Japanese Batman. Everyone knows him, even far outside the comics world, and when people think of him people think of his fierce critique of the medical world."

Palmer told me the character is often brought up in debates about medical reform. The Hitachi medical group used Black Jack's image in their advertisement in 2006, for example, because his image is synonymous with good medical care.

However, Tezuka's message was not always welcome. "There were a number of Black Jack episodes which drew complaints from the medical establishment in Japan and which Tezuka agreed to suppress and not allow to be reprinted in book form," said Gravett. Two of these three "sealed issues", issue 41 Vegetable and issue 58 Seat of Pleasure, which deal with the vegetative state and lobotomy respectively, were considered politically sensitive and never re-published.

Gravett said it was significant that Tezuka agreed to suppress this work. "Despite some ill-informed, scaremongering headlines here in the UK trying to panic the public about imported Japanese comics, manga does not operate with an anarchic, unregulated, 'anything-goes' licence," he said.

Palmer cited Naoki Urasawa's Monster and Chiho Saito's Say Hello to Black Jack as examples of manga inspired by the Black Jack series. The latter is a gritty, realistic portrait of corruption and incompetence in the Japanese medical school internship process.

"The subject of the manga is literally that every medical student in Japan starts medical school wanting to be Dr Black Jack, and then has to face the trauma of discovering that isn't possible in the real world," said Palmer. The comic is beautifully illustrated with a detailed medical realism in tribute to Tezuka.
Team Medical Dragon by Akira Nagai and Taro Nogizaka Team Medical Dragon by Akira Nagai and Taro Nogizaka

In a similar vein, Team Medical Dragon by Akira Nagai and Taro Nogizaka attacks corruption and petty politics within the Japanese healthcare system. Serialised in Japan in the manga magazine Big Comic Superior since 2002, the comic combines explanatory medical diagrams with graphic depictions of surgery. The idea was so successful it was made into the television drama Iryu which enjoyed critical acclaim when it aired in Japan between 2006 and 2007.

It is not unusual in Japan for a manga on a seemingly niche topic to gain enormous readership and become serialised on television or turned into films. "Manga covers an enormous range of topics, genres and styles of story, far more diverse than one finds in western comics, or on the animated side western television," said Palmer. "There are manga about gender-switching princes, children raised by pigeons, the bombing of Hiroshima, international competitive baking and the French Revolution."

Palmer told me that because of Tezuka's Black Jack, people in Japan are much more aware of the issue of medical corruption than in most other countries.

"Imagine if Batman were about medical corruption," said Palmer. "When a new movie comes out, the whole nation talks about it. That has had a vast impact on how the Japanese nation thinks about doctors."

Would we have manga without Tezuka? According to Gravett, the question "is rather like asking if we would have French-language comics without Hergé, or American comic books without Jack Kirby. Tezuka was pivotal and a huge inspiration [for manga artists]."

Dr Osamu Tezuka died at the age of 60 in 1989. His legacy lives on in the work of mangaka who continue to tell medical stories. The Osamu Tezuka Memorial Museum in Takarazuka showcases the life work of this prolific and talented artist.

Cian O'Luanaigh is a graphic artist and science writer based in London. He has a masters in science communication from Imperial College London

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